KALA III

Dosen Pengampu: Mona Rahayu Putri S.ST.,MKM

NAMA KELOMPOK

1. ALYA FADILAH
2. FAIQAH ZAHRA. J
3. MUTYA SYIFA SALSABILLA
4. TRINITA MUTIARA ULI HASIBUAN
5. WULANDARI
 DEFINISI KALA III

Kala III Adalah kala uri atau waktu pelepasan plasenta dari
insersinya sampai lahirnya plasenta dan selaput plasenta. Kala
tiga persalinan dimulai saat proses kelahiran bayi selesai dan
berakhir dengan lahirnya plasenta. Proses ini dikenal sebagai
kala persalinan plasenta. Normalnya pelepasan uri ini berkisar
¼ atau ½ jam sesudah anak lahir.
MEKANISME PELEPASAN URI

Kontrasi rahim akan mengurangi area uri, karena rahim bertambah kecil dan
dindingnya bertambah tebal beberapa sentimeter. Kontraksi-kontraksi tadi
menyebabkan bagian yang longgar dan lemah dari uri pada dinding rahim;
bagian ini akan terlepas, mula- mula sebagian dan kemudian seluruhnya dan
tinggal bebas dalam kavum uteri. Kadangkadang ada sebagian kecil uri yang
masih melekat pada dinding rahim.
Proses pelepasan ini biasanya setahap demi setahap dan pengumpulan darah
di belakang uri akan membantu pelepasan uri ini. Bila pelepasan uri sudah
komplit, maka kontraksi rahim mendorong uri yang sudah lepas ke SBR, lalu
ke vagina dan dilahirkan. Selaput ketubanpun dikeluarkan, sebagian oleh
kontraksi rahim, sebagian waktu keluarnya uri. Di tempat-tempat yang lepas
terjadi perdarahan antara uri dan desidua basalis, disebut retroplasenter
hematoma. Jadi jelaslah, bahwa setelah anak lahir tugas kita belum selesai,
masih ada satu hal berat yang masih dapat mengancam jiwa ibu, yaitu
pimpinan kala III dan pengawasan kala IV.
 PEMBAGIAN FASE KALA III
Fase pelepasan uri

a. Sebab-sebab terlepasnya plasenta

1. Waktu bayi dilahirkan rahim sangat mengecil. Karena pengecilan rahim, tempat perlekatan plasenta juga ikut
mengecil maka plasenta akan berlipat-lipat bahkan ada bagian – bagian yang terlepas dari dinding rahim atau tempat
insersinya, karena tidak dapat mengikuti pengecilan dari dasarnya.Jadi secara singkat, bagian yang paling penting
dalam pelepasan plasenta adalah retraksi dan kontraksi otot– otot rahim.
2. Di tempat – tempat yang lepas terjadi perdarahan ialah antara plasenta dan desidua basalis dan karena hematoma ini
membesar, maka seolah – olah plasenta terangkat dari dasarnya oleh hematoma tersebut sehingga daerah pelepasan
meluas.
b. Tanda-tanda lepasnya plasenta
3. Perubahan bentuk dan tinggi fundus
4. Tali pusat memanjang
5. Semburan darah mendadak dan singkat
 PEMBAGIAN FASE KALA III

c. Macam pelepasan plasenta yaitu :

1) Secara Schultze
Pelepasan dimulai pada bagian tengah dari plasenta dan di sini terdapat hematoma retro
plasentair yang selanjutnya mengangkat plasenta dari dasarnya. Plasenta dengan hematoma
di atasnya sekarang jatuh ke bawah atau menarik lepas selaput janin. Bagian plasenta yang
nampak dalam vulva ialah permukaan futal, sedangkan hematoma sekarang terdapat dalam
kantong yang terputar balik. Pelepasan secara schultze paling sering dijumpai.
2) Secara Duncan
Pada pelepasan secara Duncan, pelepasan dimulai dari pinggir plasenta. Darah mengalir
keluar antara selaput janin dan dinding rahim, jadi perdarahan sudah ada sejak sebagian dari
plasenta terlepas dan terus berlangsung sampai seluruh plasenta lepas. Plasenta lahir dengan
pinggirnya terlebih dahulu. Pelepasan secara Duncan terutama terjadi plasenta letak rendah.
 FASE PENGELUARAN URI
Uri yang sudah terlepas oleh kontraksi rahim akan didorong kebawah yang oleh rahim dianggap sebagai benda asing. Hal ini dibantu pula oleh
tekanan abdominal atau mengejan, maka uri akan dilahirkan, 20% secara spontan, dan selebihnya memerlukan pertolongan.

Perasat-perasat untuk mengetahui lepasnya uri:

1. Perasat Kustner 3. Perasat Klein

Tangan kanan merengangkan atau menarik sedikit tali

pusat. Tangan kiri menekan daerah diatas simfisis. Bila
tali pusat masuk kembali ke dalam vagina, berarti Wanita tersebut disuruh mengedan. Tali pusat
plasenta belum lepas dari dinding uterus. Bila tetap tampak turun kebawah, mengedannya
dan tidak masuk kembali kedalam vagian, berarti dihentikan dan tali pusat masuk kembali
plasenta lepas dari dinding uterus. Perasat ini kedalam vagian berarti plasenta telah lepas dari
hendaknya dilakukan secara hati-hati, apabila hanya dinding uterus (Prawirohardjo, 2002)
2. Perasat Strassman
sebagian plasenta terlepas, perdarahan banyak akan
dapat terjadi (Prawirohardjo, 2002).
Tangan kanan meregangkan dan menarik sedikit
tali pusat. Tangan kiri mengetok-ngetok fundus
uteri. Bila terasa getaran pada tali pusat yang
diregangkan, berarti plasenta belum lepas dari
dinding uterus. Bila tidak terasa getaran,berarti
telah lepas dari dinding uterus (Prawirohardjo,
2002).
 MANAJEMEN AKTIF KALA III

manajemen aktif kala III merupakan salah satu hal yang sangat penting dalam upaya
menurunkan kesakitan dan kematian ibu yang disebabkan perdarahan pasca persalinan.
Tujuan
manajemen aktif kala III adalah untuk menghasilkan kontraksi uterus yang lebih efektif
sehingga dapat mempersingkat waktu pada kala III, mencegah perdarahan, dan
mengurangi kehiangan darah kala III persalinan.
Manajemen aktif kala III terdiri dari tiga langkah utama
Yaitu:
1. pemberian suntikan oksitosin dalam 1 menit pertama setelah bayi lahir
2. melakukan penegangan tali pusat terkendali,
3. Massage fundus uteri (Rohani dkk, 2011).
DEFINISI PLASENTA

Placenta adalah organ sementara yang menghubungkan ibu dan

fetus dan mengirim oksigen dan nutrisi-nutrisi dari ibu ke fetus.
Placenta berbentuk cakram dan pada masa sepenuhnya
berukuran kira-kira tujuh inches dalam diameternya (garis
tengahnya). Placenta melekat pada dinding kandungan (uterus).
Placenta atau ari-ari terdiri dari vili-vili dan kotiledon yang
berfungsi untuk jalan makanan dan oksigen bagi janin.
Makanan akan diantar melalui peredaran darah yang
sebelumnya disaring terlebih dahulu melalui placenta. Placenta
juga menyaring racun maupun obat-obatan yang
membahayakan janin (Prawirohardjo, 2006).
PATOFISIOLOGI

Placenta berbentuk bundar atau hampir bundar dengan diameter

15-20 cm dan tebal 2,5 cm, berat rata-rata 500 gram. Tali pusat
berhubungan dengan placenta biasanya di tengah (insersio
sentralis). Bila hubungan agak pinggir (insersio lateralis). Bila
di pinggir placenta (insersio marginalis), kadang-kadang tali
pusat berada di luar placenta dan hubungan dengan placenta
melalui janin, jika demikian disebut (insersio velamentosa)
(Prawirohardjo, 2006).
 PATIENT MEDICAL HISTORY
Complete the patient's medical history

2005
Venus is the second planet
from the Sun 2008
Jupiter is the biggest
AGE: 25 2012 planet of them all

GENDER: FEMALE Mars is actually a very

ALLERGIES: NONE
cold place 2015
Saturn is a gas giant and
LOCATION: MADRID has several rings
 PATIENT MEDICAL HISTORY
Complete the patient's medical history

2009
Jupiter is the biggest
2010 planet of them all

Venus is the second planet

AGE: 38 from the Sun 2018
GENDER: MALE Saturn is a gas giant and

ALLERGIES: NONE
2020 has several rings

Mars is actually a very

LOCATION: MADRID cold place
 REVIEW OF SYSTEMS
Select one or more of the patient's symptoms

FEVER SMELL VOMITING

COUGH TASTE DIARRHEA
MUSCLE PAIN THROAT PAIN STOMACH
FATIGUE CONGESTION CONFUSION
HEADACHE NAUSEA CHEST PAIN
 REVIEW OF SYSTEMS
What questions would you like to ask initially?

HOW LONG HAS THIS BEEN GOING ON?

Venus is the second planet from the Sun

WHAT OTHER QUESTIONS WOULD YOU LIKE TO ASK YOUR PATIENT?

Jupiter is the biggest planet in the Solar System

WHAT OTHER SOURCES OF INFORMATION MIGHT BE USEFUL?

Saturn is a gas giant and has several rings
 PHYSICAL EXAMINATION

MERCURY MARS
Mercury is the closest planet Mars is actually a very cold
to the Sun place

VENUS NEPTUNE
Venus is the second planet It’s the farthest planet from
from the Sun the Sun
A PICTURE IS WORTH A THOUSAND WORDS
 FINDINGS
25% MARS
Mars is actually a very cold
place

30% SATURN
It’s composed of hydrogen
and helium

45% VENUS
Venus is the second planet
from the Sun Follow the link in the graph to modify its data and then paste
the new one here. For more info, click here
 DISCUSSION

DR. JENNA “Venus has a beautiful

DR. DANIEL
DOE name and is the second PATTERSON
planet from the Sun”
“Mercury is the closest “Despite being red, Mars
planet to the Sun and the is actually a cold place.
smallest in the Solar DR. JOHN It’s full of iron oxide
System” JAMES dust”
DISCUSSION
SUMMARY
“Mercury is the closest planet to the
Sun and the smallest one in the Solar
System. This planet's name has
nothing to do with the liquid metal”
 DIAGNOSIS
What examination (s) would be appropriate in this case?

MERCURY VENUS MARS

It’s the closest planet to Venus is the second planet Mars is actually a very
the Sun from the Sun cold place

JUPITER SATURN NEPTUNE

Jupiter is the biggest It’s composed of hydrogen It’s the farthest planet
planet of them all and helium from the Sun
 TREATMENT
Medical treatment

VENUS JUPITER
Venus is the second planet It’s the biggest planet in
from the Sun the Solar System

MARS SATURN
Despite being red, Mars is Saturn is a gas giant and
a cold place has several rings
 COMPARISON
Differential diagnoses

BASED ON THE WHAT ARE SOME SOME SYSTEMIC

SYMPTOMS HISTORY KNOWN CAUSES? CAUSES

FEVER Mercury is the closest Pluto is considered a Ceres is in the main

planet to the Sun dwarf planet asteroid belt

COUGH Venus has a beautiful Neptune is far away from The Moon is a natural
name, but it’s hot the Sun satellite

MUSCLE PAIN Earth is the third planet Saturn is a gas giant and Mercury is the smallest
from the Sun has rings planet

FATIGUE Jupiter is the biggest Despite being red, Mars Venus is even hotter
planet of them all is a cold place than Mercury
 PATIENT MONITORING

W.1 W.4
VENUS MARS
Venus is the second Mars is actually a very
planet from the Sun cold place

W.2 W.3
JUPITER SATURN
Jupiter is the biggest Saturn is a gas giant
planet of them all with rings
 INDICATIONS
Contraindications and indications

CONTRAINDICATIONS INDICATIONS

● You can describe the reason to stop
the treatment here
● You can describe the reason to stop
the treatment here
● You can describe the reason to stop
the treatment here
● You can describe the reason to stop
the treatment here
● You can describe the reason to
follow the treatment here
● You can describe the reason to
follow the treatment here
● You can describe the reason to
follow the treatment here
● You can describe the reason to
follow the treatment here
 POST-PREVENTION
VENUS 01 02 MERCURY
Venus is the second planet It’s the closest planet to
from the Sun the Sun

NEPTUNE 03 04 JUPITER
It’s the farthest planet It’s the biggest planet in
from the Sun the Solar System

MARS 05 06 SATURN
Despite being red, Mars is Saturn is a gas giant and
a cold place has several rings
 CASE TIMELINE
Saturn is a gas giant and has Venus is the second planet
several rings from the Sun

SATURN VENUS

WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5

MARS NEPTUNE JUPITER

Despite being red, Mars is a It’s the farthest planet from It’s the biggest planet in the
cold place the Sun Solar System
 CLINIC LOCATIONS
MERCURY
It’s the closest planet to
the Sun

JUPITER
It’s the biggest planet in
the Solar System

SATURN
Saturn is a gas giant and
has several rings
CONCLUSIONS

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“Mercury is closest “Despite being red,
planet to the Sun Mars is actually a
and the smallest” very cold place”

Add the title here 2016 2017 2018 2019 2020

“Venus is the
“Neptune is the “Saturn is a gas
second planet from
farthest-known giant and has
the Sun and is
planet from the Sun” several rings”
terribly hot”

Text 4 Text 5 Text 6

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and the smallest”

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planet to the Sun and
the smallest”
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